Risk stratification for heart failure in adults involves many clinical challenges. Elderly individuals comprise the largest subgroup of patients hospitalized for heart failure (HF). Once diagnosed with HF, older patients respond less well to guideline-based therapy than their younger counterparts, are more likely to require readmission, and are at higher risk for death.
Blood based biomarkers, including C-reactive protein (CRP), natriuretic peptides, and troponins have been advocated as adjuvants to clinical risk factors to identify community-dwelling older patients at high risk for adverse cardiovascular outcomes, but studies examining the additive prognostic value of these markers have reported inconsistent results. Hypertension is prevalent in greater than 70% of older adults and is commonly associated with left ventricular hypertrophy (LVH). Although LVH is associated with an increased risk of progression to reduced left ventricular systolic function, HF, and death, the progression to a clinical endpoint is heterogeneous occurring in only a small minority. As a result current guidelines don't recommend evaluating “at-risk” populations such as older adults for LVH. There is a need to develop a screen which allows differentiation of which patients with LVH would be at the highest risk for developing progression to heart failure (HF). In particular, identification of patients who are at risk for progression to HF with reduced ejection fraction (HFrEF) would be most advantageous as multiple therapies have been identified to halt the progression of HFrEF, improve symptoms and reduce mortality. Such therapies can also be used in patients with reduced left ventricular ejection fraction (LVEF) who are without symptoms and may have efficacy in LVH to mitigate progression to HF. However, studies of therapeutic effectiveness in LVH have been limited by the relatively low progression to symptoms. Identification of stratification of individuals at risk for new onset HFrEF would have clear advantages as specific therapies can be tested and implemented with high probability of success to reduce progression to symptomatic disease and death.